1. The landscape of prescription drug misuse in the UK
Dr David M Wood
Consultant Physician and Clinical Toxicologist, Guy’s and St Thomas’ NHS Foundation Trust and King’s Health Partners
Reader in Clinical Toxicology
King’s College London

2. Funding and Conflicts of Interest
Euro-DEN and Euro-DEN Plus
: The Euro-DEN project had financial support from the DPIP/ISEC Programme of the European Union
2015 onwards: The Euro-DEN Plus Project has received support from EMCDDA since August 2015
Rocky Mountain Poison and Drug Control Center
Grants and statistical assistance with analysis of data from UK Internet surveys and web monitoring surveys
Honorarium to attend and present at annual RADARS scientific meetings in 2014, 2015 and 2016

4. DISM: Diversion and Illicit Supply of Medicines

5. UK population level data
Crime Survey England and Wales (CSEW)
Previously the British Crime Survey
Survey of 16 to 59 year olds
Longitudinal data available on ‘tranquilisers’ only
Drug
Life-time use
Pattern of life-time use over last decade
Last year use
16 to 59 years old
Tranquiliser
2.9%
Stable ( %)
0.4%
Any drug
34.2%
Decreasing (36.7 to 34.2%)
8.5%
16 to 24 years old
2.2%
Stable ( %)
0.6%
35.7%
Decreasing (42.0 to 35.7%)
19.2%

6. UK population level data: prescription painkiller misuse
From 2014/15 CSEW survey following question included:
“Have you taken prescription-only painkillers not prescribed to you, which you took only for the feeling or experience it gave you”
Misuse
2014/15
Lifetime
2016/17
16 to 59 years old
5.4%
7.6%
16 to 24 years old
7.2%
8.0%
25 to 59 years old
4.9%
7.5%
Males
6.4%
8.3%
Females
4.4%
6.9%

7. UK population level data: prescription painkiller misuse
83% misusing painkillers had not used other drugs
Demographic factors associated with increased use
Low income <£10K 11.0% -vs- high income >£50K 6.7%)
Most deprived 9.5% -vs- least deprived 4.9%
Rural 6.7% -vs- Urban 7.8%
Low happiness 2015/ % -vs- 2016/ %
Long-term illness / disability
Drug
Yes No
Prescription painkillers
13.9%
6.5%
Any illicit drug
10.6%
8.1%
Cannabis
9.3%
6.3%

8. UK population level: Internet surveys
Undertaken by our group since 2012
Definition of non-medical use
“used without a doctor’s prescription or for any reason other than what was recommended by your doctor”
Demographics
Age, gender, income, geographical location
Non-medical use of a range of prescription medicines
Opioids, benzodiazepines, Z drugs, stimulants, GABAergics
Formulation, frequency, route
Perceived safety of prescription medicines
Association with chronic pain

9. Misuse of opioids in the UK
Stability in misuse between annual surveys
Commonest misused is codeine: OTC 44%, POM 27%
Other opioids lifetime misuse <5%
Very low rates in those associated with high use in US
Drug Class
Drug
Rate
Sustained release
Oxycontin®, Longtec®, Targnect® %
Immediate release
Oxynorm® IR tablets and liquid
0.3%
Reason for misuse
Frequency
Enjoyment / to get high
5-29%
Social reasons
2-29%
Out of curiosity
0-15%
Safer
3-21%
Prevent come-down
0-10%
Cope with stress
11-33%

10. Life-time misuse: 2012: 7.7%; 2014: 2.3%; 2015: 1.8%
Highest rates in drugs more frequently prescribed:
Diazepam (1.4%), Temazepam (0.6%), Zopiclone (0.5%)
Lower life-time misuse that benzodiazepines/’Z Drugs’
Baclofen 0.2%, Gabapentin 0.4%, Pregabalin 0.3%
Misuse associated sourcing from medical prescribing

11. Prescription drug misuse and chronic pain

12. Loperamide misuse in the UK: 2016
Survey more rapidly adaptable than CSEW
Lifetime use of loperamide in 2919 (29.2%)
135 (4.6%) reported lifetime non-medical use
Those reporting non-medical use of loperamide were
younger (42 years -vs- 47 years, p<0.001)
more likely to live in London (31% -vs- 13%, p<0.001)
more likely to report lifetime illicit drug use (41% -vs- 29%, p=0.004)
21% used loperamide for enjoyment and/or to get high
10,013 surveyed individuals
1.3% of all survey respondents

13. Prescription drug use in an MSM night-club population
Survey of 313 clubbers in South London in June 2013
Predominately male (90%) and MSM (79%)
Higher rates of misuse in MSM compared to non-MSM
Drug Group
Nightclub Survey
Comparison to population survey
Codeine products
5.8%

Other opioids
2.6% 
Benzodiazepines
30.4%

Z Drugs
18.1%
GABAergics
4.4%
Basic demographic data (age, sex, whether they had sex with men, women or both)

14. Drug Treatment Data: England

17. The majority of this release focuses on drug misuse deaths
The majority of this release focuses on drug misuse deaths. The definition of a drug misuse death is either: a death where the underlying cause is drug abuse or drug dependence, or a death where the underlying cause is drug poisoning and where any of the substances controlled under the Misuse of Drugs Act 1971 are involved

19. Discussion and Conclusions
Increasing evidence of non-medical use of prescription medicines in the UK
Predominately opioids and benzodiazepines
Less commonly with GABAergics
Misuse appears associated with certain ‘sub-populations’
Clubbers, MSM community
Those with chronic illness / pain
Significant harms being associated with misuse
Drug treatment, drug-related deaths, (ED presentations)
Understanding relationship between prescribing patterns will enable improved harm reduction strategies

20. Thank You